Brucellosis (synonym: Malta fever, a disease Bang)- infectious-allergic zoonotic disease characterized by the defeat of the reticuloendothelial, cardiovascular, nervous systems, and especially often involved in the pathological process of musculoskeletal system.
Etiology. The causative agents of brucellosis - Brucella. There are three types of Brucella - Brucella melitensis affects mainly goats and sheep, Brucella abortus causes brucellosis in cattle and Brucella suis - disease in pigs. Most pathogenic for humans Brucella melitensis. Brutally - organisms, having a form of short sticks, often globular or ovoid in shape, small in size (from 0.3 to 3 microns). In the environment they are steady, endure low temperatures and even freezing. In raw milk and milk products remain viable 20-70 days in the urine of up to 20 days. Boiling in pasteurization kills Brucella. Disinfectants - 2% carbolic acid, 3% Kremlin and Lysol, 0,2-1% bleach, 0,01% chloramine, 0.1% mercuric chloride and hydrochloric acid - kill Brucella in several minutes.
Epidemiology. The main sources of infection in humans are agricultural animals. Symptoms of brucellosis in animals are abortion (mertvorozhdennosti fruit), metritis, mastitis, arthritis, males - orchitis and other fruit, its shells, amniotic fluid, breast milk contains a high concentration of pathogens of brucellosis. Among the animals there epizootic outbreaks of brucellosis infection that can lead to mass abortions in the herd. Cases of brucellosis in animals gradually (3-5 years) to get well.
In the body of brutally penetrate through the mucous membranes of digestive tract, respiratory tract, skin. Infected mostly people caring for animals, as well as participating in the processing of animal raw material. Therefore, brucellosis people epidemiologically linked with the spread and outbreak among animals. Most frequent milkmaids, calf, farmers, shepherds, veterinarians, livestock specialists. Human infection occurs both through direct contact with sick animals, and through infected secretions, clothes, hair animals, wool. Infection occurs during the processing of raw meat, skin, fur and other Persons may also be infected by eating raw milk products, not cooked and roasted meat of animals with brucellosis, cheese, koumiss, etc. When brucellosis has been a clear seasonality of diseases typical winter-spring growth coupled with a period of calving, calving, farrowing. However, brucellosis may be logged in the whole year. The probability of transmission from a sick person to a healthy rejected, there is also no nosocomial brucellosis.
Pathogenesis and pathological anatomy. Brutally, getting into the human body, with the flow of lymph penetrate into the regional lymph nodes, causing the development of inflammatory changes (lymphadenitis). In the future they come from primary foci in the blood. Come brucelee and toxemia. Brucella are posted with the blood flow throughout the body, created new hotbeds of which in the subsequent brutally repeatedly can get into the blood, causing new escalation and recurrence of the disease. The patients formation of granulomas in the internal organs, inflammation of the small blood vessels (vasculitis), the defeat of the synovial membranesand mucous bags joints, tendons connections, fascias, nerve agents (neuritis).
The immune system. The susceptibility of people to brucellosis high. After the disease is produced quite a strong immune system. A characteristic feature of immunity in brucellosis - the ability to create cross-immunity different species of Brucella. Thus, people infected with bovine brucellosis, become strong enough immunity to Ovine brucellosis. This property is used for preparation of live attenuated vaccines from Brucella cow appearance.
The clinical picture. Brucellosis is characterized by the abundance, diversity and variability of clinical symptoms, each individual patient. Brucellosis sometimes occurs with the symptoms are severe, sometimes erased or even latent. According to the adopted in the USSR clinical classification are distinguished by the severity and duration of the disease is acute, subacute, chronic brucellosis, residual transferred brucellosis.
The incubation period when brucellosis varies from several hours to several weeks and even months (usually 1-3 weeks). The onset of the disease in most patients gradual. Prodromal period is replete with a variety of complaints. Some patients report malaise, fatigue, depression, insomnia, reduced appetite. Others complain of a headache, irritability, pain in the lumbar region, in different groups of muscles and joints, chills. May be low grade fever. Rarely, the disease starts acutely, bouts of fever with chills and sweats, without prodromal period.
In acute brucellosis phenomena of the General intoxication are accompanied by high fever, chills, sweats, severe weakness, pains in muscles and joints. Increased liver and spleen, lymph nodes. Fever can be a wave (Fig.), wrong intermittently (intermittent), remitting (sagging) and low grade (see Fever). Consciousness is retained even at high temperatures. In subacute brucellosis, along with intoxication appear focal lesions in the form of arthritis, neuritis, of plexitis and other Transition subacute chronic brucellosis in gradually and clinically difficult to detect. In chronic brucellosis disease process covers all new and new bodies, but are dominated by changes of musculoskeletal apparatus, nervous and cardiovascular systems. The temperature rarely high; low grade and even normal temperature sometimes for weeks and months (remission). Frequent acute and recurrent disease. Brucellosis is sometimes delayed for many months and even years.
Most often when brucellosis affect the musculoskeletal system. For acute forms of brucellosis characterized by pain and stiffness in the joints, muscle pain. In chronic brucellosis observed local heavy defeat of joints in the form of destructive arthritis. When brucellosis find changes in large joints and joints. Meet osteomyelitis, the spondylitis, a ankylosis, peri - and periartrit, tendovaginitis, synovitis, bursitis, fibrosity (painful lumps of connective tissue). Often affect the peripheral nervous system (neuritis, plexitis, radiculitis), rarely Central nervous system (meningitis, encephalitides, arachnoiditis, and others). Suffering greatly and cardiovascular system with a primary lesion of peripheral vessels. Typical hepato-linaly syndrome. Men often orchitis, epididimita, women - salpingit, authority, dysmenorrhea, metritis. Acute brucellosis pregnancy can result in miscarriage. Pregnancy often worsens over brucellosis, exacerbates it. After one or two years from the onset, normal pregnancy, the baby is born healthy. However, in this period described premature birth, and other mertvorozhdennosti
Diagnostics of brucellosis is based on clinical and epidemiological data. Epidemiological anamnesis - significant help in diagnosis (profession, contact with sick animals, eating infected food and other).
Given the enormous diversity of the clinical picture of brucellosis, differential diagnostics is carried out with a large group of diseases (fever, rheumatism, a tuberculosis, tularemia, sepsis, Hodgkin's disease, leishmaniasis, psittacosis, q fever, haemorrhagic fever, infectious mononucleosis, toxoplasmosis and other).
From laboratory studies with brucellosis (in the acute period and during exacerbations of chronic) produce crops blood, less bone marrow, urine. Bacteriological method is tedious, time-consuming, is possible only in special laboratories, but for diagnosis of brucellosis is crucial. In everyday practice using serological reactions (reaction agglutination). These include the reaction Wright; is the same as the reaction Vidal with typhoid fever. To obtain serum of the patient is taken from a vein 2-3 ml of blood. In the four test tubes diluted patient serum izotoniceski solution of sodium chloride: 1 - 1 : 100, 2-y - 1 : 200, 3 - 1 : 400 and 4-th - 1 : 800; in each tube add 1 to 2 drops dead culture Brucella (diagnostichna) and put in a thermostat at the temperature 37 deg on 20-24 hours, after which take into account the results. Positive reaction Wright is considered in the serum dilution of 1 : 200 and above. In the diagnostic titles it is detected with 10-11-th day of illness.
Express reaction of Heddana in modification of Soviet scientists is quite simple, sensitive and acceptable to the mass surveys. For the given reaction of Heddana taken from a finger about 1 ml of blood pooled serum should be completely transparent. Prepare a record window glass, carefully-fat alcohol divided by 6 squares. The blood serum of a patient pour using a graduated pipette into the center of each square in the following quantities: 0,08; 0,04; 0,02; 0,01 Jr. To each of these serums add one drop antigen of Heddana (dead culture of Brucella, tinted methylene blue). Then serum, starting with low doses, mixed with the antigen glass rod. Control agglutinating, properties serum put in the fifth square (0,03 ml serum and 0.03 ml izotoniceski solution of sodium chloride), and a control antigen - in the sixth square (0,03 ml antigen and 0.03 ml izotoniceski solution of sodium chloride). Next glass evenly heated for 2 minutes over the flame of the spirit lamp. If the response is positive, then after 6-8 minutes in drops of serum, to which was added diagnostikum, there are flocks, painted blue.
For diagnosis of brucellosis is also a reaction of binding complement (RAC), opsona-phagocytic reactions. In recent years, developed and offered the passive reaction of haemagglutination (TPHA), the definition of the title of opsonins, immunofluorescence method and other Widely used intradermal allergic diagnostic specimen Byrne, which is placed with brocollino and is highly sensitive, it is found in the first month of the disease and may persist even after recovery.
Using odnovremennogo syringe 0.1 ml of Brucella injected into the skin of the forearm. The test results are reading within 24 hours after its formulation. In patients with brucellosis is formed hyperemia, swelling of soft tissues, and sometimes lymphangitis. A positive test is when hyperemia of skin the size of 3,5x3, see
The forecast. In recent times less steel to meet a severe form of the disease, the Cup begins recovery. Mortality in brucellosis previously accounted for 1 - 6%, now almost absent. The Outlook for disability may be unfavorable.

Treatment of patients with brucellosis should be comprehensive, dynamic (depending on the phase of the disease), with an individual approach. In the acute period and during exacerbations of chronic brucellosis (if any phenomena of intoxication, fever) on medical paragraph may apply antibiotics (chloramphenicol, biomitsin, tetracycline, oletetrin and others). The doses normal: chloramphenicol 0.5 g 6 times a day for 5-7 days or any of drugs - biomitsin, tetracycline, oletetrin - 200 000 E D 4 times a day; course of treatment is 5-7 days. Courses drugs can be repeated after 10 days (2-3 year). Prescribing antibiotics, average health worker should consult this with your doctor. Medical assistant can be widely applied symptoms (pain - analgin, reopirin; cardiac medications). Successfully used physiotherapeutic procedures (paraffin, UHF, diathermy, sollux, quartz). In the hospital under the doctors spend a vaccine therapy, treatment with corticosteroids, ultrasound, x-ray treatments. Patients with residual effects transferred brucellosis can be sent to Spa treatment in Sernovodsk, Pyatigorsk, Tskaltubo, Sochi, Matsesta, Hot Key, etc.
Brucellosis prevention consists of a complex of veterinary, sanitary and medical and economic activities. Systematically identify animals with brucellosis, and produce their slaughter on the so-called sanitary slaughterhouses or usual in the end of the day to carry out a subsequent disinfection of the premises of the massacre 10% bleach solution. Animal skins can be salted and transfer for processing in 3 months. Culling of sick cattle do not produce earlier than 3 months. after the abortion, and in the second half of pregnancy. When forced the slaughter of cattle prohibited in terms of their meat is salted for 2 months. Breeding and pedigree cattle, sick brucellosis, contained in the insulators. Dairy products in brucellosis farms are prepared from pre-heat-treated milk. Ready cheese is aged for 2 months, hard cheese 3 months.
Staff in brucellosis farms should be provided with protective clothing (boots, overalls, head dress); which after work wipes a 3% solution of Lysol or chloramine. Adolescents and pregnant women to work in brucellosis farms do not allow. Persons working in the centers of brucellosis, vaccinated annually for 1-2 months. before the beginning of mass calving (lambing) cattle.